Nutritional status in tricuspid regurgitation: implications of transcatheter repair

Abstract

Methods and results Overall, 86 consecutive patients (mean age 78 ± 7 years) with moderate-to-severe tricuspid regurgitation (TR) at prohibitive surgical risk were analysed. Mini Nutritional Assessment (MNA), quality of life assessment, 6-min walk test distance and laboratory analyses were performed before and 1 month after TTVR. A total of 43 patients (50%) underwent concomitant transcatheter mitral valve repair. According to MNA, 81 patients (94%) were malnourished or at risk of malnutrition before TTVR. Following TTVR, MNA improved in 64 patients (74%). As compared to patients without MNA improvement, patients with increased MNA score had greater reductions in TR [regurgitation volume −17.0 (interquartile range, IQR −25.0; −7.0) mL vs. −26.4 (IQR −40.3; −14.5) mL, P < 0.001] and inferior vena cava diameter. Only patients with increased MNA score displayed a decrease in N-terminal pro-brain natriuretic peptide levels [−320 (IQR −1294; 105) pg/mL vs. +708 (IQR −342; 2708) pg/mL, P = 0.009], improvements in cholinesterase levels (0.0 ± 11.9 μmoL/L vs. +10.9 ± 16.7 μmoL/L, P < 0.001) and renal function during follow-up. Beneficial effects on quality of life scores and 6-min walk test distance following TTVR were observed exclusively in patients with improvement in MNA. During a median follow-up of 6 months, patients with worsened MNA had an increased risk of death and rehospitalization for heart failure.

Improvement in nutritional status – a determinant of successful transcatheter tricuspid valve repair?

“…Any analysis should therefore be carried out separately. In the present study, 8 50% of patients underwent TMVR + TTVR. It has so far not been assessed whether patients undergoing TMVR also benefit with regard to nutritional status.…”

“…The study by Besler and coworkers 8 very elegantly shows that, by relieving the right ventricle through a (modest) reduction in volume overload, significant improvements in exercise capacity and nutritional status in sick and frail patients are achievable. The authors are to be congratulated for their timely and innovative investigation.…”

“…This question, however, is of paramount importance as significant TR is a common condition, affecting more than 2% of individuals over the age of 75, and has recently even been referred to as a "public health crisis". 7 In this issue of the Journal, Besler et al 8 present the results of their single-centre experience with TTVR and how procedural success was related to changes in nutritional status at follow-up. Nutritional status before and after treatment was assessed by the Mini Nutritional Assessment (MNA) questionnaire.…”

“…In this issue of the Journal, Besler et al 8 . present the results of their single‐centre experience with TTVR and how procedural success was related to changes in nutritional status at follow‐up.…”

October 2020 at a glance: focus on outcomes, valve disease and patients' monitoring

“…Nutritional impairment is common in patients undergoing TTVR and has prognostic implications 9 . TTVR may improve nutritional status in some patients with severe TR and this was associated with improvement in quality of life and better outcomes 10 …”